Sustained release formulation of a non-steroidal anti-inflammatory drug

ABSTRACT

Disclosed are formulations comprising multivesicular liposomes and one or more non-steroidal anti-inflammatory drugs which minimize the side effects of unencapsulated non-steroidal anti-inflammatory drugs while maintaining or improving efficacy. Methods of making and administering the formulations comprising multivesicular liposomes and one or more non-steroidal anti-inflammatory drugs and their use as medicaments are also provided.

INCORPORATION BY REFERENCE TO RELATED APPLICATIONS

Any and all priority claims identified in the Application Data Sheet, orany correction thereto, are hereby incorporated by reference under 37CFR 1.57. This application is a continuation application, and claims thebenefit of priority to U.S. patent application Ser. No. 13/283,450,entitled “A SUSTAINED RELEASE FORMULATION OF A NON-STEROIDALANTI-INFLAMMATORY DRUG,” filed Oct. 27, 2011, which claims the benefitof priority to U.S. Provisional Application Ser. No. 61/407,872, filedOct. 28, 2010, each of which is hereby incorporated by reference in itsentirety.

BACKGROUND OF THE INVENTION

Field of the Invention

The present application relates to multivesicular liposome (MVL)formulations of non-steroidal anti-inflammatory drugs (NSAIDs) whichminimize the side effects of NSAIDs while maintaining or improvingefficacy. In particular, embodiments of the invention relate tocompositions comprising NSAIDs and multivesicular liposomes, and methodsof administration of the same. Methods of making multivesicularliposomes containing an NSAID and their use as medicaments are alsoprovided.

Background Information

NSAID compounds, administered orally, are effective relievers of painand inflammation in a variety of therapeutic settings. Because of theireffectiveness, the use of oral NSAIDs for the treatment of acute andchronic joint pain and inflammation is growing rapidly (Bjorkman, Am. J.Med., 107(6A):3S-10S (1999); Barnard et al., Drug Safety, 29(7):613-20(2007); Bardou et al., Joint Bone Spine, 77(1):6-12 (2010)). NSAIDs arealso widely used for the treatment of post-operative pain, typicallyadministered either intravenously or orally. Oral NSAID treatment,however, has been linked to a variety of serious gastrointestinalcomplications, including peptic ulcer, digestive perforation,hemorrhage, colonic ulcer, and colitis (Hollenz et al., Dig Dis.,24(1-2):189-94 (2006); Yamagata et al., Nippon Rinsho, 65(10):1749-53(2007); Shibuya et al., Colorectal Dis. (2009)). Gastro-intestinal (GI)symptoms can appear within the first two weeks of therapy. Therefore,patients with both acute and chronic conditions are affected (Peris etal., Pharmacoeconomics, 19(7):779-90 (2001)). GI toxicity, and theincreased morbidity that results from it, account for the majority ofthe cost associated with NSAID therapy (Id). It threatens both theutility and economic viability of NSAID therapy for the treatment ofpain and inflammation (Bjorkman, Am. J. Med., 107(6A):3S-10S (1999)).Gastro-protective co-therapy is being explored as a solution to the GItoxicity problem; however this approach is currently considered costprohibitive (Id.).

In general, GI toxicity is attributable to the magnitude and duration ofdrug exposure both in the GI tract following oral dosing and with highsystemic levels of drug required to achieve efficacious drug levels atthe synovial site of action. The key to improving the efficacy of NSAIDtherapy and to reducing GI or opioid-related side effects is to developa treatment that provides efficacious and prolonged levels of drugdirectly to the joint synovial cavity or surgical wound without GI orhigh systemic exposure. Effective NSAIDs such as diclofenac (DCF),meloxicam (MLX) and piroxicam (PRX) are typically systemicallyadministered at doses of 100-150 mg/day, 7.5-15 mg/day, and 20 mg/day,respectively. These relatively high, side effect-inducing doses arenecessary to achieve efficacious drug levels in the synovial cavity orwound site. The levels of drug achieved in the synovial cavity followingsystemic NSAID administration have been shown to be significantly lowerthan that of plasma (Bannwart et al., Int. J. Clin. Pharmacol. Therapy,39(1):33-36 (2001); Hundal et al., Scand. J. Rheumatol., 22(4):183-187(1993)). Chronic 100 mg/day systemic dosing of diclofenac, for instance,produces efficacious synovial fluid levels of 200 ng/mL or less. In a 25mL synovial space (this volume would represent a diseased knee; normalvolume is 2 mL), this corresponds to an intraarticular dose ofapproximately 5 μg, a dose easily achieved with formulations describedin this herein (Fowler, Eur. J. Clin. Pharmacol., 31(4):469-472 (1986)).For more potent NSAIDs such as MLX and PRX, the synovial drugconcentrations required for efficacy are expected to be much lower.

The local residence time of drug in the synovial cavity is closelyrelated to drug efficacy (Foong et al., J. Pharm. Pharmacol.,40(7):464-468 (1988); Foong et al., J. Pharm. Pharmacol., 45(3):204-209,15 (1993)). However, drugs are typically cleared in a matter of hoursfrom the synovial fluid (Neander et al., Eur. J. Clin. Pharmacol.,42(3):301-305 (1992); Larsen et al., J. Pharm. Sci., 97(11):4622-4654(2008)). Single doses of unencapsulated NSAID drugs, therefore, whetherthey are administered intraarticularly or orally, have limitedopportunity to achieve their therapeutic effect.

Methods of making liposomes encapsulating therapeutic agents, none hasbeen described in Hwang et al., Int. J. Pharm. 179(1):85-95 (1999);(Cullis et al., 1987, in Liposomes from Biophysics to Therapeutics(Ostro, Ed.), Marcel Deker Inc., pp. 60-65); and (Zhang, Trends inBio/Pharm. Ind., 4:19-24 (2008)).

The instant formulations and methods address the shortcomings of currentNSAID therapy and formulations and provide other advantages as well.

SUMMARY OF THE INVENTION

The present embodiments provide a formulation of one or morenon-steroidal anti-inflammatory drugs, comprising one or morenon-steroidal anti-inflammatory drugs; and multivesicular liposomes,wherein the one or more non-steroidal anti-inflammatory drugs areencapsulated in the multivesicular liposomes. In some embodiments, theone or more non-steroidal anti-inflammatory drugs is chosen from thegroup consisting of indomethacin, sulindac, etodolac, mefenamic acid,meclofenamic acid, meclofenamate sodium, flufenamic acid, tolmetin,ketorolac, diclofenac, diclofenac sodium, ibuprofen, naproxen, naproxensodium, fenoprofen, ketoprofen, flurbiprofen, oxaprozin, piroxicam,meloxicam, ampiroxicam, droxicam, pivoxicam, lornoxicam, cinnoxicam,sudoxicam, and tenoxicam.

In other embodiments the multivesicular liposomes further comprisecholesterol, one or more phospholipids, including salts of thephospholipids, and one or more triglycerides. In certain embodiments,the phospholipid is a phosphatidyl choline, a phosphatidyl glycerol andsalts thereof, or a combination of these. In further embodiments, thephosphatidyl glycerol is DPPG. In an additional embodiment, thephosphatidyl choline is DEPC. In an additional embodiment, thephosphatidyl choline is DOPC. In some embodiments, the triglyceride istriolein, tricaprylin, or a combination of the two.

In another embodiment, the multivesicular liposomes further comprise apH modifier. In an additional embodiment, the pH modifier is lysine orglutamic acid, or a combination thereof. In further embodiments, the pHmodifier can be an organic acid, an inorganic acid, an organic base, oran inorganic base.

In further embodiments, the multivesicular liposomes further comprise acyclodextrin. In some embodiments, the cyclodextrin is in aconcentration of from about 10 mg/ml to about 400 mg/ml complexed withthe non-steroidal anti-inflammatory drug within the multivesicularliposomes. In certain embodiments, the cyclodextrin is selected form thegroup consisting of (2,6-Di-O-)ethyl-β-cyclodextrin,(2-Carboxyethyl)-β-cyclodextrin sodium salt,(2-hydroxyethyl)-β-cyclodextrin, (2-hydroxypropyl)-α-cyclodextrin,sulfobutylether-β-cyclodextrin, (2-hydroxypropyl)-β-cyclodextrin,6-monodeoxy-6-monoamino-β-cyclodextrin, 6-O-α-maltosyl-β-cyclodextrin,butyl-β-cyclodextrin, butyl-γ-cyclodextrin,carboxymethyl-β-cyclodextrin, methyl-β-cyclodextrin,succinyl-α-cyclodextrin, succinyl-β-cyclodextrin,triacetyl-β-cyclodextrin, α-cyclodextrin β-cyclodextrin, andγ-cyclodextrin.

Another embodiment provides a method of treating pain and inflammation,comprising injecting NSAID-MVL formulations described herein into asubject in need thereof. In some embodiments, the one or morenon-steroidal anti-inflammatory drugs are chosen from the groupconsisting of indomethacin, sulindac, etodolac, mefenamic acid,meclofenamic acid, meclofenamate sodium, flufenamic acid, tolmetin,ketorolac, diclofenac, diclofenac sodium, ibuprofen, naproxen, naproxensodium, fenoprofen, ketoprofen, flurbiprofen, oxaprozin piroxicam,meloxicam, ampiroxicam, droxicam, pivoxicam, lornoxicam, cinnoxicam,sudoxicam, and tenoxicam. In other embodiments, the formulations of themethod include a pharmaceutically acceptable carrier for injection.

In further embodiments, the multivesicular liposomes further comprisecholesterol, one or more phospholipids, including salts of thephospholipid, and one or more triglycerides. In other embodiments, themultivesicular liposomes further comprise DPPG, DEPC, DOPC, tricaprylin,lysine, glutamic acid, and combinations thereof.

In some embodiments, the administration can be subcutaneous injection.In certain embodiments, administration can be intramuscular injection.In other embodiments, administration can be intraarticular injection. Insome embodiments, the administration is directly infiltrated by localinjection into the wound margin or instillation into the incision wound,or a combination thereof following surgery. In some embodiments,administration is topical. In some embodiments, topical administrationcan be ocular, nasal, or otic. In other embodiments, administration isintraocular. In additional embodiments, the administration is every 1 to7 days.

Another embodiment provides a process for preparing multivesicularliposomal formulations, the process comprising providing a firstemulsion by mixing a first aqueous phase and a volatile water-immisciblesolvent phase, said solvent phase comprising at least one amphipathiclipid and at least one neutral lipid, mixing and emulsifying said firstemulsion and a second aqueous phase to provide a second emulsion, saidsecond emulsion comprising a continuous aqueous phase, removing thevolatile water-immiscible solvent from the second emulsion to form acomposition of blank multivesicular liposomal particles; remote loadinga non-steroidal anti-inflammatory drug(s) into said multivesicularliposomes, wherein a gradient of low pH outside the MVL to high pHinside the MVL is present to drive the NSAID into the MVL.

In some embodiments, the multivesicular liposomes further comprise a pHmodifier. In further embodiments, the pH modifier is lysine or glutamicacid, or a combination thereof. In other embodiments, the pH modifiercan be an organic acid, an inorganic acid, an organic base, an inorganicbase, or a combination thereof. In additional embodiments, the glutamicacid is adjusted to a pH from about 4.7 to about 9.2. In someembodiments, the pH gradient is from about 1 to about 2 pH units.

In one embodiment, the non-steroidal anti-inflammatory drug can bediclofenac. In another embodiment, the non-steroidal anti-inflammatorydrug can be piroxicam. In another embodiment, the non-steroidalanti-inflammatory drug can be meloxicam. In another embodiment, thenon-steroidal anti-inflammatory drug can be ketorolac.

Another embodiment provides a process for preparing multivesicularliposomal formulations, the process comprising providing a firstemulsion by mixing at least one NSAID, a first aqueous phase and avolatile water-immiscible solvent phase, said solvent phase comprisingat least one amphipathic lipid and at least one neutral lipid, mixingand emulsifying said first emulsion and a second aqueous phase toprovide a second emulsion, said second emulsion comprising a continuousaqueous phase, removing the volatile water-immiscible solvent from thesecond emulsion to form a composition of blank multivesicular liposomalparticles. In some embodiments, the NSAID is added to the first aqueoussolution prior to mixing. In some embodiments, the NSAID is added to thevolatile water-immiscible solvent phase prior to mixing. In someembodiments, the NSAID is added to both the first aqueous solution andvolatile water-immiscible solvent phase prior to mixing.

In some embodiments, the multivesicular liposomes further comprise a pHmodifier. In further embodiments, the pH modifier is lysine or glutamicacid, or a combination thereof. In other embodiments, the pH modifiercan be an organic acid, an inorganic acid, an organic base, an inorganicbase, or a combination thereof.

In some embodiments, the non-steroidal anti-inflammatory drug isdiclofenac. In some embodiments, the non-steroidal anti-inflammatorydrug is piroxicam. In some embodiments, the non-steroidalanti-inflammatory drug is meloxicam. In some embodiments, thenon-steroidal anti-inflammatory drug is ketorolac.

Another embodiment provides the instant multivesicular liposomalformulations prepared by a process comprising, providing a volume offirst emulsion by mixing a first aqueous phase and a volatilewater-immiscible solvent phase, said solvent phase comprising at leastone amphipathic lipid and at least one neutral lipid, providing a volumeof second emulsion comprising a continuous aqueous phase by mixing andemulsifying said first emulsion and a second aqueous phase, removing thevolatile water-immiscible solvent from the second emulsion to form acomposition of multivesicular liposomal particles; and remote loading anon-steroidal anti-inflammatory drug into said multivesicular liposomes,wherein a gradient of low pH outside the MVL to high pH inside the MVLis present to drive the NSAID into the MVL. In some embodiments, themultivesicular liposomes further comprise a pH modifier. In furtherembodiments, the pH modifier is lysine or glutamic acid, or acombination thereof. In other embodiments, the pH modifier can be anorganic acid, an inorganic acid, an organic base, and an inorganic base,or a combination thereof. In additional embodiments, the glutamic acidis adjusted to a pH from about 4.7 to about 9.2. In some embodiments,the pH gradient is from about 1 to about 2 pH. In some embodiments, thenon-steroidal anti-inflammatory drug is diclofenac. In some embodiments,the non-steroidal anti-inflammatory drug can be piroxicam. In someembodiments, the non-steroidal anti-inflammatory drug can be meloxicam.In some embodiments, the non-steroidal anti-inflammatory drug can beketorolac.

Another embodiment provides the instant multivesicular liposomalformulations prepared by a process comprising providing a volume offirst emulsion by mixing at least one NSAID, a first aqueous phase and avolatile water-immiscible solvent phase, said solvent phase comprisingat least one amphipathic lipid and at least one neutral lipid, providinga volume of second emulsion comprising a continuous aqueous phase bymixing and emulsifying said first emulsion and a second aqueous phase,and removing the volatile water-immiscible solvent from the secondemulsion to form a composition of multivesicular liposomal particles. Insome embodiments, the NSAID is added to the first aqueous solution priorto mixing. In some embodiments, the NSAID is added to the volatilewater-immiscible solvent phase prior to mixing. In some embodiments, theNSAID is added to both the first aqueous solution and volatilewater-immiscible solvent phase prior to mixing. In some embodiments, themultivesicular liposomes further comprise a pH modifier. In furtherembodiments, the pH modifier is lysine or glutamic acid, or acombination thereof. In other embodiments, the pH modifier can be anorganic acid, an inorganic acid, an organic base, and an inorganic base,or a combination thereof. In some embodiments, the non-steroidalanti-inflammatory drug is diclofenac. In some embodiments, thenon-steroidal anti-inflammatory drug is piroxicam. In some embodiments,the non-steroidal anti-inflammatory drug is meloxicam. In someembodiments, the non-steroidal anti-inflammatory drug is ketorolac.

Another embodiment provides a method of treating pain and inflammationfor an extended period of time by wound infiltration, comprisingadministering a multivesicular liposome (MVL) formulation by localinjection into a wound margin, or instillation into an incision wound,or a combination thereof, wherein the formulation comprises one or morenon-steroidal anti-inflammatory drugs and multivesicular liposomes,wherein the one or more non-steroidal anti-inflammatory drugs areencapsulated in the multivesicular liposomes. In some embodiments, thenon-steroidal anti-inflammatory drug is chosen from the group consistingof indomethacin, sulindac, etodolac, mefenamic acid, meclofenamic acid,meclofenamate sodium, flufenamic acid, tolmetin, ketorolac, diclofenac,diclofenac sodium, ibuprofen, naproxen, naproxen sodium, fenoprofen,ketoprofen, flurbiprofen, oxaprozin piroxicam, meloxicam, ampiroxicam,droxicam, pivoxicam, lornoxicam, cinnoxicam, sudoxicam, and tenoxicam.

In one embodiment, the non-steroidal anti-inflammatory drug isdiclofenac. In another embodiment, the non-steroidal anti-inflammatorydrug is piroxicam. In another embodiment, the non-steroidalanti-inflammatory drug is meloxicam. In another embodiment, thenon-steroidal anti-inflammatory drug is ketorolac.

In some embodiments, the multivesicular liposomes further comprisecholesterol, one or more phospholipids, including salts of thephospholipids, and one or more triglycerides. In some embodiments, thephospholipid is a phosphatidyl choline, a phosphatidyl glycerol andsalts thereof, or a combination thereof. In one embodiment, thephosphatidyl glycerol is DPPG. In another embodiment, the phosphatidylcholine is DEPC. In another embodiment, the triglyceride is triolein,tricaprylin, or a combination of the two.

In some embodiments, the multivesicular liposomes further comprise a pHmodifier. In further embodiments, the pH modifier is lysine or glutamicacid, or a combination thereof. In other embodiments, the pH modifiercan be an organic acid, an inorganic acid, an organic base, an inorganicbase, or a combination thereof.

In some embodiments, the multivesicular liposomes further comprise acyclodextrin. In further embodiments, the cyclodextrin is in aconcentration of from about 10 mg/ml to about 400 mg/ml complexed withthe non-steroidal anti-inflammatory drug within the multivesicularliposomes. In certain embodiments, the cyclodextrin is selected from thegroup consisting of (2,6-Di-O-)ethyl-β-cyclodextrin,(2-Carboxyethyl)-β-cyclodextrin sodium salt,(2-hydroxyethyl)-β-cyclodextrin, (2-hydroxypropyl)-α-cyclodextrin,sulfobutylether-β-cyclodextrin, (2-hydroxypropyl)-β-cyclodextrin,6-monodeoxy-6-monoamino-β-cyclodextrin, 6-O-α-maltosyl-β-cyclodextrin,butyl-β-cyclodextrin, butyl-γ-cyclodextrin,carboxymethyl-β-cyclodextrin, methyl-β-cyclodextrin,succinyl-α-cyclodextrin, succinyl-β-cyclodextrin,triacetyl-β-cyclodextrin, α-cyclodextrin β-cyclodextrin, andγ-cyclodextrin.

DETAILED DESCRIPTION OF THE INVENTION

The present embodiments provide formulations comprising multivesicularliposomes (MVLs) containing an amount of one or more NSAIDs whichminimize the side effects of NSAIDs while maintaining or improvingefficacy (hereinafter NSAID-MVL formulations). The use of NSAID-MVLformulations in the instant embodiments results in the release of NSAIDsfor treatment of pain and inflammation for an extended period.

Intraarticular administration of the instant NSAID-MVL formulationsaddresses all of the above-mentioned shortcomings of current NSAIDtherapy by delivering drug directly to the site of action, reducing theplasma drug concentration and concentration-dependent side effects, andprolonging the drug exposure of the affected joint from hours to days orweeks, to achieve increased therapeutic benefit. The instant embodimentsare useful for acute treatment due to injury, flare-up, or surgery, aswell as for chronic conditions such as rheumatoid arthritis (RA) orosteoarthritis (OA) where the inflammation is localized to a limitednumber of joints. The instant sustained-release NSAID-MVL formulationsprovide pain relief and reduce inflammation while circumventing the sideeffects associated with current oral therapy. Using multivesicularliposome sustained-release technology, NSAID-MVL formulations can beadministered directly to the affected joint or infiltrated by localinjection into the wound margins or instilled into the incision woundfollowing surgery. The instant NSAID-MVL formulations can also beadministered by other routes of administration to treat localinflammation or pain. Local administration would include topical,ocular, intraocular, nasal, and otic delivery. Local administrationreduces the dose requirement significantly, thereby reducing thepotential for gastric and systemic toxicities associated with oral NSAIDadministration. The instant NSAID-MVL formulations release drug up totwo weeks, so patients require infrequent dosing.

Post-surgical wound infiltration of the instant NSAID-MVL formulationalso allows for a reduction in the use of opioids and therefore areduction in opioid-related side effects. Direct injection orinstillation of NSAID-MVL into the surgical site can enhance the localaction of NSAID by increasing the local tissue concentration whilereducing the overall NSAID dosing typically used in post-surgery.

Subcutaneous or intramuscular administration of the instant NSAID-MVLformulations also allow for systemic treatment of pain as an alternativeto oral therapy. The advantage of this approach is that the MVLformulation can provide a flatter pharmacokinetic profile than that fromoral immediate release dosage forms. Thus, subcutaneous or intramuscularadministration provides longer duration and decreased plasmaconcentration-related side effects.

Unless otherwise defined, all technical and scientific terms used hereinhave the same meaning as commonly understood by one of ordinary skill inthe art to which this present application belongs. Although methods andmaterials similar to those described herein can be used in the practiceor testing of the present application, suitable methods and materialsare described below. All publications, patent applications, patents, andother references mentioned herein are incorporated in the application byreference in their entirety. In addition, the materials, methods, andexamples are illustrative only and not intended to be limiting.

Non-Steroidal Anti-inflammatory Drugs

In the instant embodiments, non-steroidal anti-inflammatory drugs areencapsulated in MVLs. The NSAIDs of the present application are acidicNSAIDs. The NSAIDs include, but are not limited to, indomethacin,sulindac, etodolac, mefenamic acid, meclofenamic acid, meclofenamatesodium, flufenamic acid, tolmetin, ketorolac, diclofenac, diclofenacsodium, propionic acid derivatives such as ibuprofen, naproxen, naproxensodium, fenoprofen, ketoprofen, flurbiprofen, and oxaprozin, and enolicacids such as piroxicam, meloxicam, and other oxicams such asampiroxicam, droxicam, pivoxicam, lornoxicam, cinnoxicam, sudoxicam, andtenoxicam. In particular, the NSAIDs of the instant formulations caninclude piroxicam (PRX). The NSAIDs of the instant formulations can alsoinclude meloxicam (MLX). The NSAIDs of the instant formulations can alsoinclude diclofenac (DCF). The NSAIDs of the instant formulations canalso include ketorolac.

Multivesicular Liposomes

The instant embodiments are directed to MVLs containing one or moreNSAIDs. MVLs, reported in Kim et al. (Biochim, Biophys. Acta,728:339-348, 1983), are one of a group of large diameter syntheticmembrane vesicles which include other lipid-based delivery systems suchas unilamellar liposomes (Huang, Biochemistry, 8:334-352, 1969; Kim, etal., Biochim. Biophys. Acta, 646:1-10, 1981) and multilamellar liposomes(Bangham, et al., J Mol. Bio., 13:238-252, 1965). The main structuraldifference between multivesicular liposomes and unilamellar liposomes(also known as unilamellar vesicles), is that multivesicular liposomescontain multiple aqueous chambers per particle. The main structuraldifference between multivesicular liposomes and multilamellar liposomes(also known as multilamellar vesicles), is that in multivesicularliposomes the multiple aqueous chambers in multivesicular liposomes arenon-concentric. The structural differences between unilamellar,multilamellar, and multivesicular liposomes are illustrated in Sankaramet al., U.S. Pat. No. 5,766,627, issued Jun. 16, 1998 and Sankaram etal., U.S. Pat. No. 6,132,766 issued Oct. 17, 2000.

The structural and functional characteristics of multivesicularliposomes are not directly predictable from current knowledge ofunilamellar vesicles and multilamellar vesicles. Multivesicularliposomes have a very distinctive internal morphology, which may ariseas a result of the special method employed in the manufacture.Topologically, multivesicular liposomes are defined as having multiplenon-concentric chambers within each particle, resembling a “foam-like”matrix; whereas multilamellar vesicles contain multiple concentricchambers within each liposome particle, resembling the “layers of anonion.”

The presence of internal membranes distributed as a network throughoutmultivesicular liposomes may serve to confer increased mechanicalstrength to the vesicle. The particles themselves can occupy a verylarge proportion of the total formulation volume. The packed particlevolume (PPV) of MVLs which is measured in a manner analogous to ahematocrit, represents the volume of the formulation that the particlesmake up and can approach as high as 80%. Typically the PPV is about 50%.At 50% PPV, the multivesicular liposome formulation typically consistsof less than 5% w/w lipid. Thus, the encapsulated volume isapproximately 50% while having a relatively low lipid concentration. Themultivesicular nature of multivesicular liposomes also indicates that,unlike for unilamellar vesicles, a single breach in the externalmembrane of a synthetic membrane vesicles will not result in totalrelease of the internal aqueous contents.

Thus, multivesicular liposomes formulations consist of microscopic,spherical particles composed of numerous nonconcentric aqueous chambersencapsulating the NSAID drug to be delivered. The individual chambersare separated by lipid bilayer membranes composed of syntheticduplicates of naturally occurring lipids, resulting in a deliveryvehicle that is both biocompatible and biodegradable. The instantNSAID-MVL formulations provide either local site or systemic sustaineddelivery, and can be administered by a number of routes includingsubcutaneous, into muscle tissue, and into joints. Preparation ofmultivesicular liposomes is illustrated in Sankaram et al. (U.S. Pat.No. 5,766,627) issued on Jun. 16, 1998 and Sankaram et al. (U.S. Pat.No. 6,132,766) issued on Oct. 17, 2000.

Cyclodextrins

Cyclodextrins are chiral, toroidal-shaped molecules formed by the actionof the enzyme cyclodextrin transglycosylase on starch. These cyclicoligomers contain from 6 to 12 glucose units bonded throughα-(1,4)-linkages. The three smallest homologs, α-cyclodextrin,β-cyclodextrin and γ-cyclodextrin are available commercially; largerhomologs must be produced and isolated individually. The secondary 2-and 3-hydroxy groups line the mouth of the cyclodextrin cavity and havea staggered orientation. The primary 6-hydroxyls are at the opposite endof the molecule. The inside of the cyclodextrin cavity is relativelyhydrophobic since all hydroxyls are directed toward the outside of themolecule.

Many different types of cyclodextrins could be useful in thecompositions and methods of the present embodiments. Such cyclodextrinsinclude, but are not limited to, (2,6-di-O—)ethyl-β-cyclodextrin,(2-carboxyethyl)-β-cyclodextrin sodium salt,(2-hydroxyethyl)-β-cyclodextrin, (2-hydroxypropyl)-α-cyclodextrin,sulfobutylether-β-cyclodextrin, (2-hydroxypropyl)-β-cyclodextrin,6-monodeoxy-6-monoamino-β-cyclodextrin, 6-O-α-maltosyl-β-cyclodextrin,butyl-β-cyclodextrin, butyl-γ-cyclodextrin,carboxymethyl-β-cyclodextrin, methyl-β-cyclodextrin,succinyl-α-cyclodextrin, succinyl-β-cyclodextrin,triacetyl-β-cyclodextrin, α-cyclodextrin β-cyclodextrin, andγ-cyclodextrin.

Generally, the concentration of cyclodextrin used in preparing the MVLsof the present embodiments is that which provides an adequate solubilityor slows the release of pharmacologic compounds from the MVL afteradministration to a subject. Preferably, the cyclodextrin is present inthe liposome composition in an amount of from about 10 milligrams per mlto about 400 milligrams per ml. More preferably, the amount ofcyclodextrin in the liposome is about 100 mg/ml. The use ofcyclodextrins in preparing MVLs is described in Kim, U.S. Pat. No.5,759,573, issued Jun. 2, 1998.

Methods of Manufacturing

The formulations of the present embodiments employ NSAID encapsulatedmultivesicular liposomes (hereinafter NSAID-MVL formulations) whichencapsulate and provide modulated and sustained release of the NSAIDsdescribed above. The instant NSAID-MVL formulations are made by thefollowing process.

A “water-in-oil” type emulsion is formed from two immiscible phases, alipid phase and a first aqueous phase. The lipid phase is made up of atleast one amphipathic lipid and at least one neutral lipid in a volatileorganic solvent, and optionally cholesterol and/or cholesterolderivatives. The term “amphipathic lipid” refers to molecules having ahydrophilic “head” group and a hydrophobic “tail” group and may havemembrane-forming capability. As used herein, amphipathic lipids includethose having a net negative charge, a net positive charge, andzwitterionic lipids (having no net charge at their isoelectric point).The term “neutral lipid” refers to oils or fats that have novesicle-forming capabilities by themselves, and lack a charged orhydrophilic “head” group. Examples of neutral lipids include, but arenot limited to, glycerol esters, glycol esters, tocopherol esters,sterol esters which lack a charged or hydrophilic “head” group, andalkanes and squalenes.

The amphipathic lipid is chosen from a wide range of lipids having ahydrophobic region and a hydrophilic region in the same molecule.Suitable amphipathic lipids are zwitterionic phospholipids, includingphosphatidylcholines, phosphatidylethanolamines, sphingomyelins,lysophosphatidylcholines, and lysophosphatidylethanolamines. Alsosuitable are the anionic amphipathic phospholipids such asphosphatidylglycerols, phosphatidylserines, phosphatidylinositols,phosphatidic acids, and cardiolipins. Also suitable are the cationicamphipathic lipids such as acyl trimethylammonium propanes, diacyldimethylammonium propanes, stearylamine, and the like. Preferredamphipathic lipids include dioleyl phosphatidyl choline (DOPC),dierucoyl phosphatidylcholine or1,2-dierucoyl-sn-glycero-3-phosphocholine (DEPC), anddipalmitoylphosphatidylglycerol or1,2-dipalmitoyl-sn-glycero-3-phospho-rac-(1-glycerol) (DPPG). In certainembodiments, amphipathic lipids for the instant NSAID-MVL formulationsinclude DOPC and DEPC in conjunction with DPPG.

Suitable neutral lipids are triglycerides, propylene glycol esters,ethylene glycol esters, and squalene. Examples of triglycerides usefulin the instant formulations and methods are triolein (TO),tripalmitolein, trimyristolein, trilinolein, tributyrin, tricaproin,tricaprylin, and tricaprin. The fatty chains in the triglycerides usefulin the present application can be all the same, or not all the same(mixed chain triglycerides), including all different. Both propyleneglycol esters can be mixed diesters of caprylic and capric acids.

The concentrations of the amphipathic lipids, neutral lipids, andcholesterol present in the water-immiscible solvent used to make theMVLs typically range from 1-40 mM, 2-40 mM, and 0-60 mM, respectively.In some embodiments, the concentrations of the amphipathic lipids,neutral lipids, and cholesterol can be approximately 30 mM, 25 mM, and25 mM, respectively. If a charged amphipathic lipid is included, it isgenerally present in a lower concentration than the zwitterionic lipid.

Many types of volatile organic solvents can be used in the presentapplication, including ethers, esters, halogenated ethers, hydrocarbons,halohydrocarbons, or freon. For example, diethyl ether, chloroform,methylene chloride, tetrahydrofuran, ethyl acetate, and any combinationsthereof are suitable for use in making the formulations.

Optionally, but highly desirable, other components are included in thelipid phase. Among these are antioxidants, antimicrobial preservatives,cholesterol or plant sterols.

In certain embodiments, the first aqueous phase can include one or moreNSAIDs, pH modifiers including organic or inorganic acids and bases (forexample, lysine and glutamic acid), optionally a cyclodextrin, andosmotic agents (e.g. sodium chloride, sucrose, glucose, fructose ormixtures thereof). The lipid phase and first aqueous phase are mixed bymechanical turbulence, such as through use of rotating or vibratingblades, shaking, extrusion through baffled structures or porous pipes,or by ultrasound to produce a water-in-oil emulsion. If the NSAIDs areincluded, the NSAIDs of the present application are encapsulateddirectly (directly loaded) in the first step of MVL manufacture.

The water-in-oil emulsion can then be dispersed into a second aqueousphase by means described above, to form solvent spherules suspended inthe second aqueous phase, a water-in-oil-in-water emulsion is formed.The term “solvent spherules” refers to a microscopic spheroid droplet oforganic solvent, within which are suspended multiple smaller droplets ofaqueous solution. The second aqueous phase can contain additionalcomponents such as pH modifiers, osmotic agents and combinationsthereof. Non-limiting examples of pH modifiers include lysine, arginine,and the like. Non-limiting examples of osmotic agents includemonosaccharides (e.g., glucose and the like), disaccharides (e.g.,sucrose and the like), and polyols (e.g., sorbitol, mannitol and thelike).

The volatile organic solvent is then removed from the spherules, forinstance by surface evaporation from the suspension. When the solvent issubstantially or completely evaporated, MVLs are formed. Gases which canbe used for the evaporation include nitrogen, argon, helium, oxygen,hydrogen, and carbon dioxide, mixtures thereof, or clean compressed air.Alternately, the volatile solvent can be removed by sparging, rotaryevaporation, diafiltration or with the use of solvent selectivemembranes.

Methods of making the instant MVL formulations can also be found inHartouian et al. (WO99/25319 (PCT/US98/2426), published on May 27, 1999;US 2002-0039596, published on Apr. 4, 2002), and Schutt et al. (U.S.application Ser. No. 13/083,485, published on Oct. 13, 2011), which areincorporated by references in the present application in theirentireties.

As discussed above, NSAIDS can be incorporated in the MVL by theirinclusion in the first aqueous phase. NSAIDs can also be incorporated inthe MVL by their inclusion in the lipid phase or both the lipid andfirst aqueous phases.

Surprisingly, the instant NSAIDs may be remotely loaded into MVLs togive the instant NSAID-MVL formulations. Due to the structuralcomplexity of the MVLs, it is surprising to find that NSAIDs can bedriven through a multitude of layers of membranes of the MVLs (forexample, up to one hundred layers). The instant methods differ fromHwang et al., discussed above. For example, in the instant embodiments,the MVLs are used as the recipient for the NSAIDs, and only pH gradientsare used. Further, a gradient of low pH outside the MVLs to high pHinside the MVLs is present to drive the NSAIDs into the MVLs. Moreover,the instant embodiments do not rely on the use of calcium acetate orsodium acetate or a precipitation mechanism. Once blank MVLs (containingno active compound) are formed by the methods described above, NSAID-MVLformulations can be prepared by adding a drug-containing solution to thesuspension of MVLs. In such a case, a gradient of low pH outside theMVLs to high pH inside the MVL is present to drive the NSAID into theMVLs.

Also, remote loading can be driven by precipitation of the NSAIDs onceinside the MVLs. In such a case, a cation would be included in the blankMVLs which would form a low solubility salt with the NSAIDs. Cations caninclude, but are not limited to, sodium, calcium, magnesium, aluminumand the like.

Methods of Administration

Current modalities of post-operative analgesia include woundinfiltration with local anesthetics combined with the systemicadministration of NSAIDs and opioids. Opioid medications, which haveconsiderable drawbacks including time and resources required formonitoring and treating opioid-related side effects. A reduction in theuse of postoperative opioids is desirable to decrease the incidence andseverity of opioid-induced adverse effects, such as respiratorydepression, nausea, vomiting, constipation, somnolence, pruritus, andurinary retention. The instant embodiments provide extended releaseformulations of NSAIDs to the wound site, thus avoiding the use ofsystemic opioids.

In any of the embodiments, the instant NSAID-MVL formulations can beadministered by bolus injection, e.g., subcutaneous bolus injection,intraarticular bolus injection, intramuscular bolus injection,intradermal bolus injection and the like. In any of the embodiments,administration can be by infusion, e.g., subcutaneous infusion,intraarticular infusion, intramuscular infusion, intradermal infusion,and the like. In any of the embodiments, administration can be directwound infiltration by local injection into the wound margin orinstillation into the incision wound, or a combination thereof. TheNSAID-MVL formulations can also be administered by other routes ofadministration to treat local inflammation or pain including, but notlimited to, topical, ocular, intraocular, nasal, and otic delivery.

Administration of the instant NSAID-MVL formulations is accomplishedusing standard methods and devices, e.g., pens, injector systems, needleand syringe, a subcutaneous injection port delivery system, and thelike. See, e.g., Hall et al., U.S. Pat. No. 3,547,119, issued Dec. 15,1970; Konopka et al., U.S. Pat. No. 4,755,173, issued Jul. 5, 1988;Yates, U.S. Pat. No. 4,531,937, issued Jul. 30, 1985; Gerard, U.S. Pat.No. 4,311,137, issued Jan. 19, 1982; and Fischell et al., U.S. Pat. No.6,017,328 issued Jan. 25, 2000, each of which is herein incorporated byreference in their entirety.

In preferred embodiments, the NSAID-MVL formulations are administeredsubcutaneously, intramuscularly, or intraarticularly. Suchadministration can occur at about 1 to about 7 day intervals at a doseof from about 7.5 mg to about 200 mg for systemic use, and about 0.1 mgto about 10 mg for intraarticular use. Exact dosages will vary dependingon patient factors such as age, sex, general condition, and the like.Those of skill in the art can readily take these factors into accountand use them to establish effective therapeutic concentrations withoutresort to undue experimentation.

For systemic administration, the amount of DCF administered per day ispreferably between about 150 mg and about 200 mg. The amount of PRXadministered per day is preferably about 20 mg. The amount of MLXadministered per day is preferably between about 7.5 mg and about 15 mg.

For intraarticular administration, the amount of DCF, PRX, and MLXadministered per dose will be significantly lower than for subcutaneousadministration. For instance, the amount of DCF administered per day canbe between about 0.5 mg and about 2.0 mg. The amount of PRX administeredper day can be about 0.2 mg. The amount of MLX administered per day ispreferably between about 0.075 mg and about 0.15 mg.

In some embodiments, the NSAID-MVL formulations optionally include apharmaceutically acceptable carrier. Effective injectable compositionscontaining these compounds may be in either suspension or solution form.In the preparation of suitable formulations it will be recognized that,in general, the water solubility of the acid addition salts is greaterthan that of the free bases. Similarly, the bases are more soluble indilute acids or in acidic solutions than in neutral or basic solutions.

In the solution form the compound is dissolved in a physiologicallyacceptable vehicle. Such vehicles comprise a suitable solvent, atonicity agent such as sucrose or saline, preservatives such as benzylalcohol, if needed, and buffers. Useful solvents include, for example,water and aqueous alcohols, glycols, and carbonate esters such asdiethyl carbonate.

Injectable suspension compositions require a liquid suspending medium,with or without adjuvants, as a vehicle. The suspending medium can be,for example, aqueous solutions of sodium chloride, sucrose,polyvinylpyrrolidone, polyethylene glycol, or combinations of the above.

Suitable physiologically acceptable adjuvants are necessary to keep thecompound suspended in suspension compositions. The adjuvants may bechosen from among thickeners such as carboxymethylcellulose,polyvinylpyrrolidone, gelatin and the alginates. Many surfactants arealso useful as suspending agents. Lecithin, alkylphenol polyethyleneoxide adducts, naphthalenesulfonates, alkylbenzenesulfonates, and thepolyoxyethylene sorbitan esters are useful suspending agents.

Many substances which affect the hydrophilicity, density, and surfacetension of the liquid suspending medium can assist in making injectablesuspensions in individual cases. For example, silicone antifoams,sorbitol, and sugars can be useful suspending agents.

As used herein, the term “subject” includes animals and humans. In apreferred embodiment, the subject is a human.

Non-Limiting Disclosure and Incorporation by Reference

While certain therapeutic agents, compositions and methods of thepresent invention have been described with specificity in accordancewith certain embodiments, the following examples serve only toillustrate the compositions and methods of the invention and are notintended to limit the same.

EXAMPLES Example 1—Remote Loading

Remote-loaded NSAID-MVL formulations were manufactured as follows: blankMVL formulations were prepared in a manner similar to that reported inKim et al. (Biochim. Biophys. Acta, 728:339-348, 1983). MVLs weremanufactured wherein an aqueous solution, adjusted to specific pH, andin some cases contained cyclodextrins (Kim, U.S. Pat. No. 5,759,573,issued Jun. 2, 1998), were emulsified with a lipid-containing chloroformsolution to form a water-in-oil (W/O) emulsion. The W/O emulsion wasthen emulsified in a second aqueous solution to produce a W/O/Wemulsion. The W/O/W emulsion was then stirred at 37° C. under a nitrogenstream to remove the chloroform by evaporation. The resulting blank MVLswere centrifuged, and the supernatant was replaced with normal saline.After washing the blank MVLs were diluted into normal saline to yield aproduct with approximately a 50% packed particle volume (PPV). PPV isthe fraction of the total formulation volume taken up by the MVLparticles.

The NSAID compounds were then remote-loaded into the blank MVLs byincubating the pH-adjusted NSAID solutions described below in Tables 1,2 and 3 with the blank MVL particle suspensions, under gentle agitation.Tables 1, 2, and 3 are summaries of the components and results for theNSAID-MVL formulations wherein the NSAIDs are PRX, DCF, and MLX,respectively. After the NSAIDs had partitioned into the blank MVLs, thesuspensions were washed in normal saline to remove unencapsulated, orfree, NSAID.

Further, the MVL formulations of Table 2, above, were manufactured usingan inside:outside pH gradient with a magnitude of about 1.5. The innerand outer solutions were adjusted to a higher pH, which providedimproved DCF solubility. The loading solution contained 4.2 mg/mL DCF inNaHPO₄, pH 7.5, and the internal solution contained lysine-glutamicacid, pH 9-9.2. Using these reduced gradient-higher pH conditions,significantly higher DCF recoveries than those described in Hwang etal., above, of 17-61% (see Table 2) were obtained.

NSAID recovery in the instant MVLs was analyzed by first lysing theNSAID-containing MVL by mixing one part suspension with three partsisopropyl alcohol, vortexing to dissolution, and then further dilutingwith six parts of the RP-HPLC (reverse phase high pressure liquidchromatography) running buffer as described in the United StatesPharmacopeia method for each NSAID.

TABLE 1 Solution compositions and final product attributes for PRX-MVLFormulations Formu- Formu- Formu- Formu- Component lation 1 lation 2lation 3 lation 4 Placebo Lysine, mM 115 199 94 99 1st Glutamic acid, mM58 100 47 40 Aqueous HPB-Cyclodextrin, 10 0 13 13 Solution % pH 9.1 9.19.0 9.2 Osmolality, 295 297 296 298 mOsm/kg PRX Piroxicam, mg/mL 4.6 4.64.6 4.6 Loading NaHPO₄, mM 121 121 121 121 Solution pH 7.6 7.6 7.6 7.6Osmolality, 300 300 300 300 mOsm/kg Lipid Tricaprylin, mM 40 40 40 40Combo Cholesterol, mM 40 40 40 40 DPPG-Na+, mM 13 13 13 13 DEPC, mM 26.426.4 26.4 26.4 2nd Lysine, mM 20 20 20 20 Aqueous Sorbitol, % 4.7 4.74.7 4.7 solution pH 10 10 10 10 Osmolality, 291 291 291 291 mOsm/kgParticle d10 6.4 11.8 6.3 6.1 Size d50 13.2 20.4 12.7 12.3 Distributiond90 25.5 34.1 24.1 23.5 (PSD) Analytical Total Potency, 4.9 3.9 4.6 5.5Results mg/mL PRX Recovery % 54.3 44.7 51.3 61.8 % Free NSAID 0.4 1.20.4 0.4 PPV % 54.2 54.9 53.5 52.8

TABLE 2 Solution compositions and final product attributes for DCF-MVLFormulations Formu- Formu- Formu- Formu- Component lation 5 lation 6lation 7 lation 8 Placebo Lysine, mM 115 78 94 99 1st Glutamic acid, mM58 39 47 40 Aqueous HPB-Cyclodextrin, 10 15 13 13 Solution % pH 9.1 9.09.0 9.2 Osmolality, 295 296 296 298 mOsm/kg DCF Diclofenac, mg/mL 4.24.2 4.2 4.2 Loading NaHPO₄, mM 121 121 121 121 Solution pH 7.5 7.5 7.57.5 Osmolality, 302 302 302 302 mOsm/kg Lipid Tricaprylin, mM 40 40 4040 Combo Cholesterol, mM 40 40 40 40 DPPG-Na+, mM 13 13 13 13 DEPC, mM26.4 26.4 26.4 26.4 2nd Lysine, mM 20 20 20 20 Aqueous Sorbitol, % 4.74.7 4.7 4.7 solution pH 10 10 10 10 Osmolality, 291 291 291 291 mOsm/kgParticle d10 6.4 5.6 5.6 6.6 Size d50 11.9 10.6 11.0 13.0 Distributiond90 21.0 18.9 19.6 24.3 Analytical DCF Recovery, % 17 26 29 61 ResultsTotal Potency, 5.8 4.9 5.4 6.9 mg/mL % Free NSAID 2.6 1.9 1.6 0.8 PPV %47.2 47.9 46.5 46.5

TABLE 3 Solution compositions and final product attributes for MLX-MVLFormulations Formulation Formulation Formulation Formulation FormulationFormulation Component 9 10 11 12 13 14 Placebo Lysine, mM 40 40 40 40115 40 1st Aqueous Glutamic acid, mM 20 20 20 20 58 20 Solution HPB-CD,% 20 10 9.5 (SBE)* 10 10 20 pH 9.0 9.0 9.1 9.0 9.1 9.0 Osmolality,mOsm/kg 301 292 302 301 298 297 MLX Meloxicam, mg/mL 6 6 6 4.8 4.8 4.8Loading NaHPO₄, mM 126 126 126 120 120 120 Solution pH 8.0 8.0 8.0 8.08.0 8.0 Osmolality, mOsm/kg 304 304 304 295 295 295 Lipid ComboTricaprylin, mM 40 40 40 40 40 40 Cholesterol, mM 40 40 40 40 40 40DPPG-Na₊, mM 11.2 11.2 11.2 11.2 11.2 11.2 DEPC, mM 26.4 26.4 26.4 26.426.4 26.4 2nd Lysine, mM 20 20 20 20 20 20 Aqueous Sorbitol, % 4.8 4.84.8 4.8 4.8 4.8 solution pH 10 10 10 10 10 10 Osmolality , mOsm/kg 291291 291 291 291 291 Particle Size d10 6.1 6.3 9.7 6.8 7.6 6.7Distribution d50 12.3 13.1 18.3 14.1 16.0 13.8 d90 24.2 24.9 33.9 28.346..0 31.7 Analytical Total Potency, mg/mL 3.4 2.9 2.2 2.7 3.4 3.2Results MLX Recovery % 56.4 49.3 37.4 55.4 71.2 67.1 % Free 0.8 1.0 2.80.9 1.1 1.0 PPV % 55 55 56 52 51 51 pH 7.1 7.0 7.0 6.9 7.5 7.3 *SBEmeans sulfobutylether β-cyclodextrin

As shown in Table 4 below, in formulations containing 182 mMlysine/glutamic acid (+5 mM Calcium Acetate (Ca(OAc)₂)), DCF loading washigher in formulations comprised of longer-chain phosphatidylcholine(83% vs. 0% recovery in DEPC versus dioleylphosphatidylcholine (DOPC)).Formulations containing lysine/glutamic acid at higher concentration(182 vs. 93 mM) and increased pH gradient (9.0 vs. 7.5) had improved DCFloading (78% v 43% recovery). In 300 mM lysine/glutamic acidformulations, increasing the DCF loading concentration to 4.6 mg/mlresulted in batch failure. In 100 mM lysine/glutamic acid formulations,encapsulation and recovery decreased with increasing DCF concentrationin the loading solution. Encapsulation and recovery were improvedsignificantly by adding between about 2 to about 10% HPB-CD. In someembodiments 2% HPB-CD can be added. In further embodiments 3% HPB-CD canbe added. Likewise, 4% HPB-CD can be added. In additional embodiments,between about 5 and about 9% HPB-CD can be added. In furtherembodiments, between about 6 to about 15% HPB-CD can be added. Infurther embodiments, between about 2 to about 15% HPB-CD can be added.

In lysine/glutamic acid only formulations, addition of 15% HPB-CD withosmolarity adjustment enabled an increase in the DCF encapsulation ofthe particles to 4.6 mg/mL (67% recovery). HPB-CD was not required toachieve high encapsulation (7.2 mg/mL) with other NSAIDS (i.e. PRX). InHPB-CD-containing lysine/glutamic acid formulations,higher-concentration buffer conditions still provided improvedencapsulation and recovery.

TABLE 4 Impact of phosphatidylcholine (PC) chain length, bufferconcentration, and HPB-CD on NSAID encapsulation. Loading Final Blanksolution^(a) Loading drug particle drug conc, Solution potency, % DrugFormulation composition mg/mL pH PC mg/mL Recovery DCF A 5 mM Ca(OAc)₂,182 mM 0.52 7.0 DEPC 0.43 83 LysGlut, pH 9.0 DCF B 5 mM Ca(OAc)₂, 182 mM0.65 7.0 DOPC na failed LysGlut, pH 9.0 DCF C 5 mM Ca(OAc)₂, 182 mM 1.16.9 DEPC 0.85 78 LysGlut, pH 9.0 DCF D 5 mM Ca(OAc)₂, 93 mM 1.1 6.9 DEPC0.46 43 LysGlut, pH 7.5 DCF E 300 mM LysGlut, 0% HBP-CD, 4.6 7.5 DEPC naFailed pH 9 DCF F 100 mM LysGlut, 2% HBP-CD, 1.1 7.0 DEPC 0.9 83 pH 9DCF G 100 mM LysGlut, 10% HBP- 1.1 7.0 DEPC 1.0 96 CD, pH 9 DCF H 100 mMLysGlut, 2% HBP-CD, 3.2 7.4 DEPC 2.0 62 pH 9 DCF I 100 mM LysGlut, 10%HBP- 3.2 7.4 DEPC 2.3 72 CD, pH 9 DCF J 117 mM LysGlut, 15% HBP- 4.6 7.5DEPC 4.6 67 CD, pH 9 DCF K 60 mM LysGlut, 15% HBP-CD, 4.6 7.5 DEPC 3.146 pH 9 PRX L 300 mM LysGlut, 0% HBP-CD, 4.5 7.5 DEPC 7.2 80 pH 9 PRX M173 mM LysGlut, 10% HBP- 4.5 7.5 DEPC 5.0 55 CD, pH 9 ^(a)Drug loadingsolutions were prepared in 150 mM sodium phosphate, unless otherwiseindicated.

In addition to the formulations manufactured using lysine-glutamic acidsolutions, blank MVLs were also manufactured using lysine-acetic acidsolutions (as summarized in Table 5 below). Table 5 is a summary of thecomponents and results for DCF-MVL formulations remote loaded usinglysine and acetic acid. A low internal pH blank MVL was alsoinvestigated. The pH of the blank MVL was as low as 2.1 units below theloading solution. A significantly lower concentration of lysine-aceticacid solution was employed (10-25 mM versus 120-150 mM calcium or sodiumacetate as reported by Hwang). This approach of employing lowerconcentration of lysine-acetic acid solution led to NSAID loadingthrough the use of a membrane permeable acid such as acetic acid.Recovery in NSAID-MVL formulations was higher in solutions with higherpH as exemplified below in Table 5.

TABLE 5 DCF-MVL particles remote-loaded using lysine and acetic acidFormu- Formu- Formu- Component lation 15 lation 16 lation 17 BlankLysine, mM 25 25 25 Particles Acetic acid, mM 20 20 20 Internal particlepH 4.7 7.7 8.7 DCF Loading DCF-Na, mg/mL 1.0 1.0 1.0 Solution NaPO₄, mM150 150 150 pH 6.9 6.9 6.9 pH gradient (in:out) −2.2 0.8 1.8 LipidTricaprylin, mM 10 10 10 Solution Cholesterol, mM 25 25 25 DPPG-Na+, mM5.6 5.6 5.6 DEPC, mM 26.4 26.4 26.4 Second Lysine, mM 45 45 45 AqueousAcetic acid, mM 20 20 20 solution Sorbitol, % 4.2 4.2 4.2 pH 9.2 9.2 9.2Osmolality, 301 301 301 mOsm/kg Wash/Storage Lysine, mM 20 20 20solution Acetic acid, mM 40 20 20 pH 4.6 7.0 8.7 Osmolarity, 288 288 290mOsm/kg Final DCF Recovery, % 36 74 71 Product Total Potency, 0.34 0.700.67 mg/mL % Free NSAID 5.1 4.5 3.5 PPV % 45.1 46.5 46.5

Example 2—Direct Loading

Direct-loaded NSAID-MVL formulations were manufactured as follows: MVLscontaining an NSAID were produced by traditional direct-loading methodswherein the active (NSAID) drug is dissolved in the first aqueoussolution and then encapsulated as described in Hartouian et al.,(WO99/25319 (PCT/US98/2426), published on May 27, 1999, and US2002-0039596, published on Apr. 4, 2002). As shown in Table 6, thisapproach yielded MVL particles with NSAID encapsulated at either lowefficiencies or not at all.

TABLE 6 Direct loading of NSAIDs into MVLs Lipid composition Potency,Drug Formulation 1^(st) Aqueous (PC) mg/mL % Recovery PRX N 2 mg/mL PRXin DEPC 0.021 2 70 mM LysGlut, pH 8.3 DCF O 10 mg/mL DCF in DOPC 0failed^(a) 50 mM MegluminePO₄, pH 7.5 DCF P 4 mg/mL DCF in DOPC/DEPC 0failed^(a) 50 mM MegluminePO4, pH 7.5 DCF Q 1 mg/mL DCF in DOPC/DEPC 0 020 mM PBS, pH 6.5 DCF R 1 mg/mL DCF*Na in DOPC 0 failed^(a) 293 mMArginineGlut, 3% HBP-CD, pH 9 DCF S 0.2 mg/mL DCF*Na in DEPC 0 0 149 mMLysGlut, pH 8.5 DCF T 1 mg/mL DCF*Na in DEPC 0 0 149 mM LysGlut, pH 8.5DCF U 1 mg/mL DCF*Na in DEPC 0.032 <6  100 mM LysGlut, 20% HBP-CD, pH 9^(a)Failed indicates that MVL particles were not formed or were grosslyaggregated.

MVLs containing DCF were also produced by placing NSAID in either thelipid solution alone (at concentrations up to the solubility in thesolvent), or portions of the NSAID in both the first aqueous solutionand the lipid solution (see Table 7 below). This approach was useful forthe manufacture of MVLs, often producing final NSAID concentrationsbetween 0.1 and 1 mg/mL.

TABLE 7 DCF partitioning from lipid solution (or lipid and aqueousphases) into MVLs DCF conc. (mg/mL) in Potency, Drug Formulation 1^(st)Aqueous ± DCF Lipid solution mg/mL % Recovery DCF V 148 mMLysineGlutamate, pH 8.5 2 mg/mL DCF-A in 0 0 DEPC lipid solution DCF W148 mM LysineGlutamate, pH 8.5 8 mg/mL DCF-A in 0.04 1.1 DEPC lipidsolution DCF X 149 mM LysineGlutamate, pH 8.5 20 mg/mL DCF-A in 0.14 1.2DEPC lipid solution DCF Y 148 mM LysineGlutamate, pH 8.5 16 mg/mL DCF-Ain 0.18 2.9 DEPC lipid solution DCF Z 0.5 mg/mL DCF*Na in 16 mg/mL DCF-Ain 0.18 2.8 148 mM LysineGlutamate, pH 8.5 DEPC lipid solution DCF AA 4mg/mL DCF free acid (DCF-A) in 20 mg/mL DCF-A in 0.22 1.5 26 mM Lysine,pH 9.1 DEPC lipid solution DCF BB 3.8 mg/mL DCF-A in 20 mg/mL DCF-A in0.78 6.6 29 mM LysineGlutamate, pH 9 DEPC lipid solution

Example 3—Stability

The stability of the instant NSAID-MVL formulations (stored in Type Iborosilicate glass vials, sealed with ETFE-faced grey butyl stoppers) isacceptable by industry standards. Stability data for the Formulations inTables 1 and 2 above are shown in Tables 8 and 9 below. Propertiesassessed included drug content (“Total”) and percent of unencapsulateddrug (% free) by RP-HPLC methods, packed particle volume (“PPV”) whichis assessed in a manner analogous to a hematocrit, and particle sizewhich is assessed by laser light scattering. At refrigeratedtemperatures (5° C.), no significant changes are observed through 3months.

TABLE 8 Storage stability for DCF-MVL at 5° C. Total Brief Incub'n [DCF]Formulation Component Time (mg/ % % Free Sup Int # Description Yield (d)mL) PPV DCF d10 d50 d90 pH pH Formulation (10% HPB- 17.2 0 5.82 47.22.58 6.4 11.9 21.0 6.8 8.38 5 CD, pH 9.0) 30 5.74 43.0 6.01 6.6 13.024.0 7.53 8.34 115:58 97 5.91 42.9 — — — — 7.15 8.31 Lysine:Glut acidFormulation (15% HPB- 26.0 0 4.90 47.9 1.92 5.6 10.6 18.9 6.75 8.15 6CD, pH 9.0) 30 4.60 41.0 3.87 5.7 11.0 19.6 7.28 8.08 78:39 97 5.10 45.02.78 — — — 7.45 8.09 Lysine:Glut acid Formulation (13% HPB- 28.8 0 5.3946.5 1.60 5.6 11.0 19.6 6.64 8.20 7 CD, pH 9.0) 30 5.26 42.0 4.24 5.710.9 19.4 7.45 8.21 94:47 97 5.65 44.3 2.99 — — — 7.09 8.18 Lysine:Glutacid Formulation (13% HPB- 61.3 0 6.90 46.5 0.83 6.6 13.0 24.3 6.50 8.218 CD, pH 9.2) 30 6.69 42.0 4.73 6.5 12.2 21.4 7.44 8.32 99:40 97 6.8643.6 3.93 — — — 6.95 8.23 Lysine:Glut acid

TABLE 9 Storage stability for PRX-MVL at 5° C. Brief Incub'n TotalComponent Incub'n Time [PRX] % % Free Int Formulation Description YieldTemp (d) (mg/mL) PPV PRX pH d10 d50 d90 Formulation 1 (10% HPB-CD, 54.3%5° C. 0 4.94 54.2 0.42 8.27 6.4 13.2 25.5 pH 9.0) 5° C. 30 5.14 52.02.03 8.23 6.5 13.5 26.0 115:58 mM 5° C. 97 4.86 55.7 2.29 8.24 — — —Lysine:Glut acid Formulation 2 (Buffer only, pH 44.7% 5° C. 0 3.91 54.91.22 8.69 11.8 20.4 34.1 9.0) 5° C. 30 4.06 48.0 5.56 8.69 12.3 21.135.3 199:100 mM 5° C. 97 3.78 52.1 6.06 8.69 — — — Lysine:Glut acidFormulation 3 (13% HPB-CD, 51.3% 5° C. 0 4.60 53.5 0.37 8.14 6.3 12.724.1 pH 9.0) 5° C. 30 4.79 51.0 2.15 8.09 6.5 13.0 24.8 94:47 mM 5° C.97 4.44 52.9 2.93 8.10 — — — Lysine:Glut acid Formulation 4 (13% HPB-CD,61.8% 5° C. 0 5.45 52.8 0.36 8.32 6.1 12.3 23.5 pH 9.2) 5° C. 30 5.7350.0 2.20 8.30 6.2 12.4 23.5 99:40 mM 5° C. 97 5.62 52.1 1.92 8.28 — — —Lysine:Glut acid

While the present invention has been described with reference to thespecific embodiments thereof, it should be understood by those skilledin the art that various changes may be made and equivalents may besubstituted without departing from the true spirit and scope of theinvention. In addition, many modifications may be made to adapt aparticular situation, material, composition of matter, process, processstep or steps, to the objective, spirit and scope of the presentinvention. All such modifications are intended to be within the scope ofthe claims appended hereto.

What is claimed is:
 1. A method of treating pain and inflammation for anextended period of time by wound infiltration, comprising administeringa multivesicular liposome (MVL) formulation by local injection into awound margin, or instillation into an incision wound, or a combinationthereof, wherein the formulation comprises: meloxicam; andmultivesicular liposomes, said multivesicular liposomes comprise atleast one amphipathic phospholipid and at least one neutral lipid,wherein said meloxicam is encapsulated in a first aqueous phase of themultivesicular liposomes, wherein the first aqueous phase comprises a pHmodifier; and wherein the multivesicular liposomes are characterized byan internal pH of about 8 to about
 9. 2. The method of claim 1, whereinthe multivesicular liposomes comprise cholesterol, one or morephosphatidyl glycerols or salts thereof, one or more phosphatidylcholines or salts thereof, and one or more triglycerides.
 3. The methodof claim 2, wherein the phosphatidyl glycerols comprise DPPG.
 4. Themethod of claim 2, wherein the phosphatidyl cholines comprise DEPC. 5.The method of claim 2, wherein the triglyceride is selected fromtriolein, tricaprylin, or a combination of the two.
 6. The method ofclaim 1, wherein the pH modifier comprises lysine or glutamic acid, or acombination thereof.
 7. The method of claim 1, wherein the pH modifiercomprises an inorganic acid.
 8. The method of claim 1, wherein the pHmodifier comprises an organic base.
 9. The method of claim 1, whereinthe pH modifier comprises an inorganic base.
 10. The method of claim 1,wherein the multivesicular liposomes further comprise a cyclodextrin.11. The method of claim 10, wherein the cyclodextrin is in aconcentration of from about 10 mg/ml to about 400 mg/ml complexed withmeloxicam within the multivesicular liposomes.
 12. The method of claim10, wherein said cyclodextrin is selected from the group consisting of(2,6-Di-O-)ethyl-β-cyclodextrin, (2-Carboxyethyl)-β-cyclodextrin sodiumsalt, (2-hydroxyethyl)-β-cyclodextrin, (2-hydroxypropyl)-α-cyclodextrin,sulfobutylether-β-cyclodextrin, (2-hydroxypropyl)-β-cyclodextrin,6-monodeoxy-6-monoamino-β-cyclodextrin, 6-O-α-maltosyl-β-cyclodextrin,butyl-β-cyclodextrin, butyl-γ-cyclodextrin,carboxymethyl-β-cyclodextrin, methyl-β-cyclodextrin,succinyl-α-cyclodextrin, succinyl-β-cyclodextrin,triacetyl-β-cyclodextrin, α-cyclodextrin β-cyclodextrin, andγ-cyclodextrin.
 13. The method of claim 1, wherein the pH modifiercomprises an organic acid.
 14. The method of claim 1, wherein theformulation is configured for administration at an interval of about 1to about 7 days.